Many strokes cause strength or movement impairments that affect one side of the body (including arms and legs). This is referred to as Hemiparesis or Hemiplegia.
Weakness or paralysis can also occur in the head or neck areas. Examples include weakness or paralysis of eye, face, or tongue movement, or difficulty swallowing.
Other Signs and Symptoms include fairly sudden or unexpected onset of:
If you notice any of these signs or symptoms, IMMEDIATELY seek emergency care. Strokes are medical emergencies, and time is of the essence. Even one hour can mean the difference between successful and unsuccessful treatment. Some medical care is only effective if performed within hours of the time that symptoms started.
Common physical deficits after stroke include the following:
1. Hemipareis and Hemiplegia
2. Spasticity: Spasticity refers to when muscles become stiff and tight. This can affect range of motion and ability to perform many tasks such as walking or activities of daily living.
3. Contractures: Contractures refer to extreme stiffness and bending in the arms or legs that occurs when spasticity is left unmanaged. Contractures are caused by the shortening of muscles or connective tissue that spans one or more joints
4. Post-Stroke Fatigue: Fatigue is common following strokes. As the brain tries to heal itself, this can be a drain on your loved one’s energy. This means:
If excessive sleeping continues later in recovery, speak to your loved one’s doctor. Persistence of increased sleeping and fatigue may indicate another medical condition.
5. Balance Issues: If your loved one’s motor abilities were affected by a stroke, they may have poor balance and be at an increased risk of falling. Therefore, it’s essential to be even more vigilant about preventing falls.
6. Dysphagia (Difficulty swallowing): Your loved one’s brain might need to be retrained to control the swallowing muscles.
7. Shoulder complications: Your loved one may experience shoulder pain on the affected side when shoulder muscles are affected by the stroke. Pain or motion difficulty with the shoulder can extend into the arm or hand.
8. Foot Drop: Your loved one may have difficulty lifting their foot on the affected side.
9. Curled Toes: Your loved one may curl their toes as a result of spasticity in the feet.
10. Learned Nonuse: If your loved one fails to move their muscles, they may develop nonuse, which causes the brain to have increased difficulty paying attention to the affected muscles.
Many long-lasting physical and other impairments can result from a stroke; these are called “residuals.” Residuals usually require treatment by physical, occupational, and/or speech therapy (PT, OT, ST).
1. Aphasia: Aphasia refers to difficulty with language, and is common after certain types of stroke.
The two main types of aphasia that may occur are:
1. Expressive aphasia – the person can understand what is said to them and what they hear. They know what they want to say to respond. However, when they try to speak, the speech comes out garbled or nonsensical.
2. Receptive aphasia – the person can hear what is said but they cannot make sense of it.
Either or both types of aphasia can occur from a stroke. Aphasia can also apply to reading and writing. You can help your loved one by:
1. Getting Speech Therapy
2. Developing alternate forms of communication
2. Impaired Memory and Attention: A stroke can affect your loved one’s ability to think clearly, reason, focus, remember, and execute everyday cognitive functions. To help, your loved one can be prescribed cognitive training. Different types of healthcare professionals can render cognitive training or therapy.
3. Behavior Changes: Your loved one may express angry or aggressive behaviors after suffering from a stroke. Check with your health care provider if this occurs.
4. Depression and Anxiety: This is one of the most common complications after a stroke, and can be best treated by a neurologist, primary care provider, or mental health professional.
When sensory functions sustain damage following a stroke, it can cause sensory issues such as numbness, pain, or visual disturbances.
As a result, your loved one may need:
1. Bedsores: Your loved one can develop bedsores if they are laying or sitting for long periods. Help prevent bedsores by repositioning the body every couple of hours. You will need training on how to do this properly and effectively. You may need to hire a trained professional to provide this care; always double-check your insurance coverage before hiring someone. If your loved one is in a facility (e.g., skilled nursing facility), this care will be provided by the facility.
2. Seizures: Some stroke survivors experience seizures. If this happens to your loved one, they may be prescribed an anticonvulsant medication. In severe cases where drugs are ineffective, the doctor may recommend a nerve stimulator.
3. Aspiration: There are two types:
1. Acute (sudden) - when stroke survivors with impaired swallowing accidentally inhale food or saliva into the lungs. Aspiration can lead to pneumonia or other serious lung problems. Contact medical professionals immediately if you suspect an unplanned aspiration has occurred.
2. Chronic - some stroke patients frequently aspirate, regardless of medical attempts to prevent this. These patients are managed differently than those with acute aspiration, and throat surgery may be suggested.
4. Deep Vein Thrombosis (Blood clot in a vein): Your loved one has an increased risk of developing a blood clot if:
In either situation, your loved one’s doctor will likely prescribe blood-thinning medication.
5. Post-Stroke Headaches: Chronic headaches may develop after the acute phase of a stroke. Many things can cause these headaches. After evaluation by a doctor, follow the prescribed treatment(s).
For unexpected new-onset headaches (those that the doctor is not already well aware of):
These symptoms could signal critical bleeding in the brain or another life-threatening medical situation.
For new-onset mild headaches without any other signs or symptoms, notify a healthcare provider if simple treatment (e.g., Tylenol™) doesn’t promptly resolve the situation. Never take it upon yourself to treat recurring or ongoing mild headaches without the care of a medical professional. If in doubt, always contact a professional promptly.
Rehab often begins during acute hospitalization for a stroke. After discharge from the hospital, stroke patients are frequently discharged to skilled nursing (or similar) facilities to continue their PT, OT, ST and/or cognitive therapy.
The duration of rehab will vary widely depending on the individual’s particular situation.
NOTE: At some point, stroke survivors will experience a plateau in the rate at which improvements occur with ongoing therapy. This is due to neurological changes stabilizing. At a certain point, further gains may be limited or not possible with continued treatment.
After a stroke, patients may have conditions that make them more likely to fall such as:
Home modifications to reduce risk of injury or other dangers may be needed such as:
NOTE: Your loved one’s PT and/or OT program should be consulted for recommendations specific hoe modifications that are tailored to your loved one’s specific situation.
Stephen Engle is a United States-trained physician (M.D.) and Diplomate of the American Board of Internal Medicine who is board-certified in internal medicine. He has experience as a medical director in administrative medicine with the largest private payer in the US, as well as experience in internal medicine at all levels (clinic, urgent care, emergency room, inpatient general and intensive care, clinical consultative medicine, and peer review.)